[Latent and Active Tuberculosis Infection in Patients with Inflammatory Bowel Disease]

Abstract

Latent tuberculosis (TB) infections (LTBI) impose clinical challenges in terms of the diagnosis and treatment of inflammatory bowel disease (IBD), especially in TB-endemic areas. While steroids and biologics have become increasingly useful in the treatment of patients with moderate-to-severe IBD, the risk of reactivation or developing TB is increased due to their potent immunosuppressive effects. Tumor necrosis factor-alpha inhibition may result in the activation of a latent TB infection, and most cases manifest as more severe forms of disseminated TB. All potential users of immunosuppressive therapy should be screened for LTBI, and appropriate measures for the management of latent and active TB should be undertaken with immediate initiation of anti-TB treatment. Biologics should be withheld during TB treatment, and the proper timing for the resumption of IBD therapy during or after TB treatment should be individualized. This review summarizes the latest knowledge on the risk assessment, detection, and management of latent and active TB infections in patients with IBD.

Keywords: Biological therapy; Inflammatory bowel disease; Latent tuberculosis; Tuberculosis infection.

Fig. 1

Algorithm for the diagnosis of latent tuberculosis infection in patients with IBD. IBD, inflammatory bowel disease; Sx, symptom; CXR, chest X-ray; TST, tuberculin skin test; IGRA, interferon-γ releasing assay; LBTI, latent tuberculosis infection.